Drug interactions
Diclofenac + Lithium
Severity: Major
Diclofenac and Lithium: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Diclofenac can raise serum lithium concentrations, potentially leading to lithium toxicity with tremor, confusion, ataxia, vomiting and seizures. The effect is variable but clinically important given lithium's narrow therapeutic index.
What this interaction means in plain words
Diclofenac and Lithium can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Diclofenac belongs to Musculoskeletal; Lithium belongs to Central Nervous System.
Why it happens
NSAID inhibition of renal prostaglandins reduces renal blood flow and lithium clearance, increasing proximal lithium reabsorption.
What to do
Avoid the combination if possible; if used, measure lithium levels at baseline and within the first week and after changes, and reduce lithium dose as needed. Counsel patients on signs of toxicity.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Diclofenac
- Diclofenac + Ketorolac Contraindicated
- Diclofenac + Ketorolac intranasal Contraindicated
- Aceclofenac + Diclofenac Major
- Acemetacin + Diclofenac Major
- Alteplase + Diclofenac Major
- Amiloride + Diclofenac Major
Other interactions of Lithium
- Lithium + Thioridazine Contraindicated
- Lithium + Vandetanib Contraindicated
- Aceclofenac + Lithium Major
- Acemetacin + Lithium Major
- Amisulpride + Lithium Major
- Amlodipine-benazepril + Lithium Major
Frequently asked questions
Can I take Diclofenac with Lithium?
MediHelp rates the interaction as major. Diclofenac and Lithium can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Diclofenac can raise serum lithium concentrations, potentially leading to lithium toxicity with tremor, confusion, ataxia, vomiting and seizures. The effect is variable but clinically important given lithium's narrow therapeutic index.
How serious is the interaction between Diclofenac and Lithium?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination if possible; if used, measure lithium levels at baseline and within the first week and after changes, and reduce lithium dose as needed. Counsel patients on signs of toxicity.
What other medicines interact with Diclofenac?
MediHelp also lists interactions of Diclofenac with, for example, Ketorolac, Ketorolac intranasal, Aceclofenac. The full list is on the Diclofenac page.
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